Notice to Test Orderers

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Medicare Coverage of Laboratory Testing

1.    Only those laboratory tests that are reasonable and necessary for the diagnosis or treatment of the patient will be covered by Medicare.  A physician should carefully consider the medical need for each test ordered.

2.    An individual who knowingly causes a false claim to be submitted to any of the Federal health care programs may be subject to civil, criminal, and administrative sanctions or remedies.  The term “false claim” may encompass a variety of actions, including falsifying records, double-billing for items or services, submitting bills for services never performed or items never furnished, or knowingly or with deliberate disregard upcoding (billing for a more highly reimbursed service or product than the one provided).

3.    Viracor Eurofins and client-customized panels should be billed to Medicare only when every component of the customized panel is medically necessary.  Unless necessary for clinical or regulatory reasons, all tests may be ordered individually.

4.    Medicare National Limitation Amounts for Current Procedural Terminology (CPT) codes are available through CMS or its contractors.  Medicaid reimbursement will be equal to or less than the amount of Medicare reimbursement.

For reimbursement amounts for tests performed by Viracor Eurofins, please refer to the Medicare Clinical Laboratory Fee Schedule.

     Medicare Coverage Database:
     http://www.cms.gov/medicare-coverage-database/overview-and-quick-search.aspx

     The Medicare Clinical Laboratory Fee Schedule:
     http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ClinicalLabFeeSched/clinlab.html

5.    Clients may contact Viracor Eurofins' Clinical Laboratory Director for information or questions about testing.  The Clinical Laboratory Director is Michelle Altrich, PhD, HCLD who can be reached at MichelleAltrich@Viracor-Eurofins.com or by calling client services at 1-800-305-5198.

6.    The American Medical Association CPT codes published on Viracor Eurofins Test Directory are provided for informational purposes only. The codes reflect our interpretation of CPT coding requirements based upon AMA guidelines published annually. CPT codes are provided only as guidance to assist clients with billing.  We strongly recommend that clients confirm CPT codes with their Medicare administrative contractor, as requirements may differ.  CPT coding is the sole responsibility of the billing party, and Viracor Eurofins assumes no responsibility for billing errors due to reliance on the CPT codes published.